Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
JAMA Netw Open. 2023 May 1;6(5):e2313172. doi: 10.1001/jamanetworkopen.2023.13172.
Research on patients with high health care costs has examined mainly adults, with little focus on mental health care use.
To examine the characteristics and costs of children and adolescents with high health care costs who use mostly mental health care and whether and why they persist in the high-cost state.
DESIGN, SETTING, AND PARTICIPANTS: This population-based, retrospective cohort study used health care records from Ontario, Canada, on all children and adolescents (age 0-17 years) covered under a universal health care system from January 1, 2012, to December 31, 2019. All children and adolescents in and above the 90th percentile of the cost distribution in 2012 for whom costs related to mental health care accounted for 50% or more of their costs were defined as patients with high mental health care costs. Data were analyzed from August 2019 to December 2022.
High health care costs.
Patients with high mental health care costs were characterized in terms of their sociodemographic characteristics; chronic physical health, mental health, and behavioral conditions; and health care costs (in 2021 Canadian dollars) by health service and type of care (mental health care vs non-mental health care). Patients were followed up until 2019 to assess whether they persisted in the high-cost state and to examine factors associated with persisting in that state.
In 2012, there were 273 490 children and adolescents with high health care costs (mean [SD] age, 6.43 [5.99] years; 55.8% male; mean cost, $7936.40; 95% CI, $7850.30-$8022.40). Of these, 20 463 (7.5%) were classified as having high mental health care costs (mean cost, $10 040.20; 95% CI, $9822.80-$10 257.50). Asthma (30.3%), attention-deficit/hyperactivity disorder (35.8%), and mood and/or anxiety disorders (94.9%) were the most common chronic physical, behavioral, or mental health conditions. Few patients with high mental health care costs persisted in the high-cost state beyond 3 years (19.0%). Mood and/or anxiety disorders (relative risk ratio [RRR], 6.17; 95% CI, 3.19-11.96) and schizophrenia spectrum disorders (RRR, 2.98; 95% CI, 2.14-4.14) were identified as the main factors associated with persistence in the high-cost state.
In this cohort study of children and adolescents with high health care costs, some patients had high levels of mental health care use and high costs of care, but few of these persisted in the high-cost state for 3 or more years. These findings may help inform the development of care coordination interventions and service delivery models, such as youth integrated services, to reduce costs and improve outcomes for children and adolescents.
针对高医疗费用患者的研究主要集中在成年人，很少关注精神卫生保健的使用情况。
研究主要使用精神卫生保健的高医疗费用儿童和青少年的特征和费用，以及他们是否以及为何持续处于高费用状态。
设计、地点和参与者：本基于人群的回顾性队列研究使用了来自加拿大安大略省的健康记录，研究对象为 2012 年 1 月 1 日至 2019 年 12 月 31 日期间在一个全民健康保险制度下的所有 0-17 岁的儿童和青少年（年龄）。所有儿童和青少年中，在 2012 年成本分布的第 90 百分位以上，且与精神卫生保健相关的成本占其成本的 50%或以上的患者被定义为精神卫生保健高成本患者。数据于 2019 年 8 月至 2022 年 12 月进行分析。
高医疗费用。
根据社会人口统计学特征；慢性身体、精神健康和行为状况；以及健康服务和护理类型（精神卫生保健与非精神卫生保健）的健康保健费用（以 2021 年加元计算），对高精神卫生保健费用患者进行了特征描述。对患者进行了随访，直到 2019 年，以评估他们是否持续处于高费用状态，并研究与持续处于该状态相关的因素。
2012 年，有 273490 名高医疗费用的儿童和青少年（平均[标准差]年龄，6.43[5.99]岁；55.8%为男性；平均费用为 7936.40 加元；95%CI，7850.30-8022.40）。其中，20463 人（7.5%）被归类为高精神卫生保健费用患者（平均费用为 10040.20 加元；95%CI，9822.80-10257.50）。最常见的慢性身体、行为或精神健康状况为哮喘（30.3%）、注意缺陷多动障碍（35.8%）和情绪或焦虑障碍（94.9%）。很少有高精神卫生保健费用的患者在 3 年以上持续处于高费用状态（19.0%）。情绪或焦虑障碍（相对风险比[RRR]，6.17；95%CI，3.19-11.96）和精神分裂症谱系障碍（RRR，2.98；95%CI，2.14-4.14）被确定为持续处于高费用状态的主要相关因素。
在这项针对高医疗费用儿童和青少年的队列研究中，一些患者的精神卫生保健使用水平和护理费用较高，但很少有患者持续处于高费用状态 3 年或更长时间。这些发现可能有助于制定护理协调干预措施和服务交付模式，例如青少年综合服务，以降低成本并改善儿童和青少年的结果。
